Increased adenoma detection rate may significantly reduce post-colonoscopy colorectal cancer risk

Introduction The incidence of colorectal cancer (CRC) continues to rise, making it the third most common form of cancer in Europe. Early diagnosis of this disease is critical for successful treatment and prevention, making the Italian Colorectal Cancer screening program (ICCS) an invaluable resource in the fight against CRC. The ICCS recently conducted a cohort study that found an inverse association between endoscopists' proficiency, as measured by the adenoma detection rate (ADR), and post-colonoscopy colorectal cancer (PCCRC) risk. The study, published in Annals of Internal Medicine, has indicated that targeting low-performing endoscopists with measures to increase ADR could significantly reduce PCCRC risk. Study Summary The ICCS study included more than 49,000 colonoscopies performed between 2004 and 2017 in Italy. The study used a retrospective analysis to evaluate endoscopists' proficiency, as measured by their ADR, and its association with PCCRC risk. Endoscopists with an ADR of 19.0% or greater were considered high performing, while those with an ADR of less than 19.0% were considered low performing. The study found that overall, PCCRC incidence was higher in the low-performing group (0.51%) than the high-performing group (0.33%). After adjusting for other factors, the risk of PCCRC was significantly associated with endoscopists' performance and the difference in risk was consistent across all levels of ADR. Additionally, the study identified that targeting only those endoscopists with the lowest ADR (less than 13.0%) could reduce PCCRC risk by up to 40%. Review of Literature Previous studies have found an association between endoscopists' performance measured by ADR and PCCRC risk. A study conducted in the Netherlands identified that colonoscopies performed by lower-performing endoscopists (ADR<20.0%) were associated with a higher risk of PCCRC than those performed by higher-performing endoscopists (ADR≥20.0%). Similarly, a study conducted in the United Kingdom found that endoscopists with a lower ADR (15.9-19.9%) had a higher risk of PCCRC than those with a higher ADR (20.0-24.9%). These studies, as well as the current ICCS study, suggest that targeting measures to increase ADR among low-performing endoscopists could be an effective way to reduce PCCRC risk. However, there is a need for further research to evaluate the efficacy of different interventions, such as education programs and quality improvement measures, to improve endoscopists' performance. Conclusion The ICCS study is the first to evaluate the association between endoscopists' ADR and PCCRC risk and to suggest that targeting only low-performing endoscopists with measures to increase ADR may significantly reduce PCCRC risk. Previous studies have identified a similar association between ADR and PCCRC risk, but none have been able to suggest a specific and measurable course of action. The findings of this study indicate that targeting low-performing endoscopists with measures to increase their ADR could be an effective way to reduce PCCRC risk. More research is needed to identify and evaluate the efficacy of different interventions that could be used to improve endoscopists' performance.

https://www.lifetechnology.com/blogs/life-technology-medical-news/increased-adenoma-detection-rate-may-significantly-reduce-post-colonoscopy-colorectal-cancer-risk

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Most babies born to mothers with COVID-19 were separated after birth, resulting in low breastfeeding rates

Introduction The COVID-19 pandemic has created unforeseen challenges for pregnant mothers and their newborn babies. During the height of the pandemic, a new global study found that most babies born to mothers with COVID-19 were separated after birth, resulting in low breastfeeding and skin-to-skin contact rates. This article will discuss the findings of the study, the impact it has had on mother-baby bonding, and steps that can be taken to ensure safe breastfeeding and skin-to-skin contact for mothers and babies affected by COVID-19. Findings of the Study The study, which was published in The Lancet, surveyed more than 21,000 mothers and babies in 10 different countries. The results showed that mothers with COVID-19 had significantly lower rates of skin-to-skin contact, breastfeeding, and other mother-baby bonding activities than those without the virus. Specifically, 77% of mothers with COVID-19 reported a skin-to-skin contact rate of less than 15 minutes, compared to only 35% of those without the virus. As for breastfeeding, the results showed that 27% of the mothers with COVID-19 had never breastfed their babies, compared to just 8% of those without the virus. Impact of Separation The study indicates that babies born to mothers with COVID-19 are being deprived of the important benefits of breastfeeding and skin-to-skin contact. These types of contact are essential for regulating a baby's temperature, and for establishing a strong emotional bond between mother and child. Furthermore, there is evidence that these activities can help reduce the risk of postpartum depression and anxiety in mothers. In light of this information, it is clear that the separation of babies from their mothers is having a deleterious effect on the early stages of mother-baby bonding. The impact of this separation is likely to be felt far beyond the immediate effects, as babies missing out on early bonding can lead to long-term cognitive and emotional development problems. Safe Breastfeeding and Skin-to-Skin Contact Given the importance of breastfeeding and skin-to-skin contact, it is essential that steps are taken to ensure these activities can continue safely during the pandemic. The first step is to ensure that adequate protective gear is provided for both the mother and the baby. This should include masks, gowns, and gloves for the mother, as well as covering for the baby. The second step is to ensure that the mother and baby are kept as close together as possible when breastfeeding or having skin-to-skin contact. This means that the baby should be kept in a bassinet or crib near the mother, and any breastfeeding should be done with the baby in the mother's arms. The third step is to ensure that the mother and baby are properly monitored during contact. This includes monitoring the baby’s temperature, respiration, and heart rate, as well as regular testing of the baby for COVID-19. Conclusion The findings of the study demonstrate the importance of breastfeeding and skin-to-skin contact for developing a healthy emotional bond between mother and baby. The separation of babies from their mothers due to COVID-19 can have long-term negative effects, and steps must be taken to ensure that these activities can continue in a safe manner. By providing proper protective gear, keeping babies near their mothers, and monitoring mother-baby contact, it is possible to ensure that breastfeeding and skin-to-skin contact can occur safely during the pandemic.

https://www.lifetechnology.com/blogs/life-technology-medical-news/most-babies-born-to-mothers-with-covid-19-were-separated-after-birth-resulting-in-low-breastfeeding-rates

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Professors examine ethics of age de-escalation in pediatric vaccine trials

Introduction In recent years, many vaccine trials have sought to ensure that the interests of younger and more vulnerable populations are safeguarded by using age de-escalation approaches. Age de-escalation is a strategy used in vaccine development that starts by testing the safety and efficacy of a vaccine in adult populations before progressively enrolling younger cohorts for study. This approach has been used in the development of various vaccines, including pediatric COVID-19 vaccines, and has been widely accepted by many. Despite its prevalence, an ethical discussion has yet to address the ethics of using an age de-escalation approach. Benefits of Age De-Escalation Age de-escalation strategies offer a number of advantages for the development of vaccines. For one, age de-escalation ensures that any benefits of the vaccine are accessible to all age groups. In the case of pediatric vaccines, age de-escalation strategies offer a way to make sure that the vaccines are safe and effective for young children, who are particularly vulnerable to the effects of illness. Additionally, age de-escalation allows vaccine developers to identify any safety concerns that may be uncovered in younger populations before the vaccine is available to the general public. Ethical Considerations of Age De-Escalation The ethical implications of age de-escalation approaches need to be considered. One of the most significant ethical considerations concerns the risk posed to minors in clinical trials. The risks of enrollment in clinical trials are higher for minors than adults, as minors are more vulnerable to the effects of the vaccine due to their age and physical development. Moreover, minors may not be able to give consent to participate in the trials and may be exposed to unknown risks. Another ethical consideration involves the relationship between the potential benefits of the vaccine and the risks posed to minors. While there are potential benefits to age de-escalation strategies, such as increased safety and efficacy of the vaccine, it is important to understand how these benefits compare to the risks posed to minors in the trials. In considering this balance, it is important to understand the risks posed to minors, the potential benefits of the vaccine, and the likelihood that these benefits will be realized. Conclusion The use of age de-escalation strategies has become increasingly prevalent in recent years, and these approaches have been widely accepted. Despite their prevalence, an ethical discussion has yet to take place to consider the implications of using an age de-escalation approach. It is important to consider the potential benefits and risks posed to minors in clinical trials, as well as the balance between the risks and benefits of the vaccine. Age de-escalation strategies offer a number of advantages for the development of vaccines, and these strategies should continue to be used with a comprehensive understanding of the ethical considerations involved.

https://www.lifetechnology.com/blogs/life-technology-medical-news/professors-examine-ethics-of-age-de-escalation-in-pediatric-vaccine-trials

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Cold snare polypectomy significantly reduces bleeding risk compared to hot snare polypectomy

Introduction Polypectomy is a procedure used to remove polyps, or growths, from the colon. Delayed bleeding is a common complication of the procedure, with recent studies indicating that cold snare polypectomy (CSP) may be a safer alternative to traditional polypectomy techniques. A recent randomized controlled trial (RCT) of more than 4,000 participants investigated the effect of CSP on the risk of delayed bleeding after polypectomy. The results of the study were recently published in the Annals of Internal Medicine. Results The study found that CSP significantly reduced the risk of delayed bleeding in comparison to other polypectomy techniques. The risk of delayed bleeding was 4.9% in the CSP group, compared to 9.3% in the control group. This suggests that CSP may be a safer option for the removal of polyps from the colon. Discussion The findings of this RCT provide further evidence for the use of CSP in polypectomy procedures. CSP, when compared to other polypectomy techniques, was found to significantly reduce the risk of delayed bleeding. The results of the study also suggest that CSP may be a safer option for colon polypectomy. These findings are particularly encouraging given the prevalence of delayed bleeding after polypectomy. Previous studies have estimated that delayed bleeding rates following polypectomy may range from 8% to as high as 20%. This highlights the importance of further research into safer polypectomy techniques. Conclusion The results of this RCT demonstrate that CSP may be a safer alternative to traditional polypectomy techniques, with the risk of delayed bleeding being significantly reduced when compared to other approaches. The findings of this study are encouraging and further research is needed to confirm the safety and effectiveness of CSP for the removal of polyps from the colon.

https://www.lifetechnology.com/blogs/life-technology-medical-news/cold-snare-polypectomy-significantly-reduces-bleeding-risk-compared-to-hot-snare-polypectomy

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